tbuckley/cabot-search huggingface dataset:
Clinical Outcomes and Cost Associated With an Intravascular Microaxial Left Ventricular Assist Device vs Intra-aortic Balloon Pump in Patients Presenting With Acute Myocardial Infarction Complicated by Cardiogenic Shock
Authors: P. Elliott Miller, Samantha G. Bromfield, Qinli Ma, Geoffrey Crawford, John Whitney, Andrea DeVries, Nihar R. Desai
Journal: JAMA Internal Medicine (2022)

<h3>Importance</h3> Intravascular microaxial left ventricular assist device (LVAD) compared with intra-aortic balloon pump (IABP) has been associated with increased risk of mortality and bleeding among patients with acute myocardial infarction (AMI) and cardiogenic shock (CS) undergoing percutaneous coronary intervention (PCI). However, evidence on the association of device therapy with a broader array of clinical outcomes, including data on long-term outcomes and cost, is limited. <h3>Objective</h3> To examine the association between intravascular LVAD or IABP use and clinical outcomes and cost in patients with AMI complicated by CS. <h3>Design, Setting, and Participants</h3> This retrospective propensity-matched cohort study used administrative claims data for commercially insured patients from 14 states across the US. Patients included in the analysis underwent PCI for AMI complicated by CS from January 1, 2015, to April 30, 2020. Data analysis was performed from April to November 2021. <h3>Exposures</h3> Use of either an intravascular LVAD or IABP. <h3>Main Outcomes and Measures</h3> The primary outcomes were mortality, stroke, severe bleeding, repeat revascularization, kidney replacement therapy (KRT), and total health care costs during the index admission. Clinical outcomes and cost were also assessed at 30 days and 1 year. <h3>Results</h3> Among 3077 patients undergoing PCI for AMI complicated by CS, the mean (SD) age was 65.2 (12.5) years, and 986 (32.0%) had cardiac arrest. Among 817 propensity-matched pairs, intravascular LVAD use was associated with significantly higher in-hospital (36.2% vs 25.8%; odds ratio [OR], 1.63; 95% CI, 1.32-2.02), 30-day (40.1% vs 28.3%; OR, 1.71; 95% CI, 1.37-2.13), and 1-year mortality (58.9% vs 45.0%; hazard ratio [HR], 1.44; 95% CI, 1.21-1.71) compared with IABP. At 30 days, intravascular LVAD use was associated with significantly higher bleeding (19.1% vs 14.5%; OR, 1.35; 95% CI, 1.04-1.76), KRT (12.2% vs 7.0%; OR, 1.88; 95% CI, 1.30-2.73), and mean cost (+$51 680; 95% CI, $31 488-$75 178). At 1 year, the association of intravascular LVAD use with bleeding (29.7% vs 24.3%; HR, 1.36; 95% CI, 1.05-1.75), KRT (18.1% vs 10.9%; HR, 1.95; 95% CI, 1.35-2.83), and mean cost (+$46 609; 95% CI, $22 126-$75 461) persisted. <h3>Conclusions and Relevance</h3> In this propensity-matched analysis of patients undergoing PCI for AMI complicated by CS, intravascular LVAD use was associated with increased short-term and 1-year risk of mortality, bleeding, KRT, and cost compared with IABP. There is an urgent need for additional evidence surrounding the optimal management of patients with AMI complicated by CS.
Association of Demographic, Clinical, and Social Determinants of Health With COVID-19 Vaccination Booster Dose Completion Among US Veterans
Authors: Karen H. Seal, Daniel Bertenthal, Jennifer K. Manuel, Jeffrey M. Pyne
Journal: JAMA Network Open (2022)

This cohort study investigates the association of demographic, clinical, and social determinants of health with COVID-19 booster completion among enrollees in the US Veterans Health Administration to identify vulnerable subpopulations.
The Devil Hides in the Details—Rare Electrocardiogram Findings in a Patient in Their 50s
Authors: Xiao-Yan Yang, Chang-Qing Zhong, Yi Zhang
Journal: JAMA Internal Medicine (2022)

This case report describes a patient in their 50s who presented to the emergency department with dyspnea, palpitations, fatigue, and syncope, following a fever and symptoms of an upper respiratory tract infection.
Identification of Three Different Phenotypes in Anti–Melanoma Differentiation–Associated Gene 5 Antibody–Positive Dermatomyositis Patients: Implications for Prediction of Rapidly Progressive Interstitial Lung Disease
Authors: Lingxiao Xu, Hanxiao You, Lei Wang, Chengyin Lv, Fenghong Yuan, Ju Li, Min Wu, Zhanyun Da, Hua Wei, Wei Yan, Lei Zhou, Songlou Yin, Dongmei Zhou, Jian Wu, Yan Lu, Dinglei Su, Zhichun Liu, Lin Liu, Longxin Ma, Xiaoyan Xu, Yinshan Zang, Huijie Liu, Tianli Ren, Fang Wang, Yan Du, Jing Xue, Miaojia Zhang, Wenfeng Tan
Journal: Arthritis & Rheumatology (2022)

There is substantial heterogeneity among the phenotypes of patients with anti-melanoma differentiation-associated gene 5 antibody-positive (anti-MDA5+) dermatomyositis (DM), hindering disease assessment and management. This study aimed to identify distinct phenotype groups in patients with anti-MDA5+ DM and to determine the utility of these phenotypes in predicting patient outcomes.A total of 265 patients with anti-MDA5+ DM were retrospectively enrolled in the study. An unsupervised hierarchical cluster analysis was performed to characterize the different phenotypes.Patients were stratified into 3 clusters characterized by markedly different features and outcomes. Cluster 1 (n = 108 patients) was characterized by mild risk of rapidly progressive interstitial lung disease (RPILD), with the cumulative incidence of non-RPILD being 85.2%. Cluster 2 (n = 72 patients) was characterized by moderate risk of RPILD, with the cumulative incidence of non-RPILPD being 73.6%. Patients in cluster 3 (n = 85 patients), which was characterized by a high risk of RPILD and a cumulative non-RPILD incidence of 32.9%, were more likely than patients in the other 2 subgroups to have anti-Ro 52 antibodies in conjunction with high titers of anti-MDA5 antibodies. All-cause mortality rates of 60%, 9.7%, and 3.7% were determined for clusters 3, 2, and 1, respectively (P < 0.0001). Decision tree analysis led to the development of a simple algorithm for anti-MDA5+ DM patient classification that included the following 8 variables: age >50 years, disease course of <3 months, myasthenia (proximal muscle weakness), arthritis, C-reactive protein level, creatine kinase level, anti-Ro 52 antibody titer, and anti-MDA5 antibody titer. This algorithm placed patients in the appropriate cluster with 78.5% accuracy in the development cohort and 70.0% accuracy in the external validation cohort.Cluster analysis identified 3 distinct clinical patterns and outcomes in our large cohort of anti-MDA5+ DM patients. Classification of DM patients into phenotype subgroups with prognostic values may help physicians improve the efficacy of clinical decision-making.
Impaired Chromatin Remodeling Predicts Better Survival to Modified Gemcitabine and S-1 plus Nivolumab in Advanced Biliary Tract Cancer: A Phase II T1219 Study
Authors: Nai-Jung Chiang, Kien Thiam Tan, Li-Yuan Bai, Chin-Fu Hsiao, Chung-Yu Huang, Yi-Ping Hung, Chien-Jui Huang, San-Chi Chen, Yan-Shen Shan, Yee Chao, Yi-Hsiang Huang, I-Cheng Lee, Pei-Chang Lee, Yung-Yeh Su, Shu-Jen Chen, Chun-Nan Yeh, Li-Tzong Chen, Ming-Huang Chen
Journal: Clinical Cancer Research (2022)

Abstract Purpose: Modified gemcitabine and S-1 (GS) is an active regimen for patients with advanced biliary tract cancer (ABTC) in our previous study. Herein, we report the results of a single-arm phase II of nivolumab plus modified GS (NGS) as first-line treatment in ABTC. Patients and Methods: Patients received nivolumab 240 mg and 800 mg/m2 gemcitabine on day 1 plus daily 80/100/120 mg of S-1 (based on body surface area) on days 1 to 10, in a 2-week cycle. The primary endpoint was the objective response rate (ORR). The correlation between therapeutic efficacy and genetic alterations with signatures identified by targeted next-generation sequencing panels was explored. Results: Between December 2019 and December 2020, 48 eligible patients were enrolled. After a median of 17.6 months of follow-up, the ORR was 45.9% [95% confidence interval (CI), 31.4%–60.8%]. The median progression-free survival (PFS) and overall survival (OS) was 9.1 (95% CI, 5.8–9.6) and 19.2 (95% CI, 11.6–not reached) months, respectively. All grade 3/4 treatment-related adverse events (AE) were less than 10%, except fatigue (14.6%) and skin rash (10.4%). Eighteen patients (35.4%) experienced immune-related AEs without treatment-related death. High tumor mutational burden (TMB-H; top 20%; ≥7.1 mut/Mb) only predicted prolonged median PFS but not OS. Up to 28.9% of patients who harbored loss-of-function mutations in chromatin remodeling genes demonstrated significantly longer median PFS and OS than those without alterations. Conclusions: NGS is a safe and promising regimen in ABTC. Impaired functions of chromatin remodeling genes may be a potential surrogate biomarker with predictive value in this study.
Disparities in Early Intervention Program Participation by Children With Autism Spectrum Disorder in a US Metropolitan Area, 2006 to 2016
Authors: Josephine Shenouda, Emily Barrett, Amy L. Davidow, Kate Sidwell, William Halperin, Vincent M. B. Silenzio, Walter Zahorodny
Journal: JAMA Pediatrics (2022)

<h3>Importance</h3> Multiple studies have shown the value of early interventions for autism spectrum disorder (ASD). In the US, the Early Intervention Program (EIP) is mandated by law (Part C of the Individuals With Disabilities Education Act [IDEA]) to provide services to all young children with delays or disabilities. However, the extent to which children with ASD participate in this key service system is unknown. <h3>Objectives</h3> To evaluate EIP use by children with ASD from 2006 to 2016 and to describe the factors associated with EIP participation. <h3>Design, Setting, and Participants</h3> This cross-sectional study used repeated data collected from 2006 to 2016 by active ASD surveillance of the New York–New Jersey metropolitan area as reported in the New Jersey Autism Study. The New Jersey Autism Study identified 4050 children aged 8 years with ASD from 2006 to 2016. Demographic and clinical data were collected and participation in an EIP was assessed through active surveillance. Data were analyzed from June to December 2021. <h3>Exposure</h3> Sociodemographic factors associated with the outcome of EIP participation. <h3>Main Outcomes and Measures</h3> Participation in an EIP assessed at age 8 years. Demographic, ecological, and clinical factors, as well as temporal patterns, were examined by using standard and multilevel logistic regression models. <h3>Results</h3> Among 4050 children aged 8 years with ASD by active surveillance, 1887 (46.6%) received EIP services. Of these children, 3303 (81.6%) were boys; 1105 (27.3%) were Hispanic, 801 (19.8%) were non-Hispanic Black, 1816 (44.8%) were non-Hispanic White, and 328 (8.1%) were non-Hispanic other (included Alaska Native or American Indian and Asian or Pacific Islander). In adjusted regression models, non-Hispanic Black children with ASD had lower odds of EIP participation (adjusted odds ratio [AOR], 0.67; 95% CI, 0.54-0.84) compared with their non-Hispanic White peers, and children residing in affluent areas had higher odds of receiving EIP services (AOR, 1.71; 95% CI, 1.36-2.15) compared with children residing in underserved areas. Children with ASD born in 2008 had higher odds of EIP participation than children born in 1998 (AOR, 2.64; 95% CI, 2.07-3.36). <h3>Conclusions and Relevance</h3> Early identification of ASD is an important public health priority and receipt of EIP services may improve ASD outcomes. Approximately half of the population of children aged 8 years with ASD received EIP services between 2006 and 2016, and EIP participation by children with ASD increased during the 10-year period. However, receipt of EIP services was marked by strong socioeconomic status– and race and ethnicity–based disparities. Universal ASD screening and additional strategies are needed to address disparities and to increase access to EIP services.
Analysis of Hospitalization and Mortality by Race and Ethnicity Among Adults With Variceal Upper Gastrointestinal Hemorrhage, 2008-2018
Authors: Umer Farooq, Zahid Ijaz Tarar, Harleen Kaur Chela, Veysel Tahan, Ebubekir Daglilar
Journal: JAMA Network Open (2022)

the Rockall score.
Correct Diagnosis for the Proper Treatment of Acute Vertigo—Putting the Diagnostic Horse Before the Therapeutic Cart
Authors: Jonathan A. Edlow, Yuri Agrawal, David E. Newman-Toker
Journal: JAMA Neurology (2022)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA Neurology HomeNew OnlineCurrent IssueFor Authors Podcast Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA Neurology journal
An Alternate Explanation for Bifascicular Block With QRS Complex Axis Change
Authors: Sandeep Bansal
Journal: JAMA Internal Medicine (2022)

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA Internal Medicine HomeNew OnlineCurrent IssueFor Authors Podcast Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA Internal Medicine journal
Neurobehavior in the Neonatal Intensive Care Unit—Window to the Future?
Authors: Sara B. DeMauro, Stephanie Merhar
Journal: JAMA Network Open (2022)

Elisabeth C. McGowan, MD; Julie A. Hofheimer, PhD; T. Michael O’Shea, MD; Howard Kilbride, MD; Brian S. Carter, MD; Jennifer Check, MD; Jennifer Helderman, MD, MPH; Charles R. Neal, MD, PhD; Steve Pastyrnak, PhD; Lynne M. Smith, MD; Marie Camerota, PhD; Lynne M. Dansereau, MSPH; Sheri A. Della Grotta, MPH; Barry M. Lester, PhD
Childcare Stress, Burnout, and Intent to Reduce Hours or Leave the Job During the COVID-19 Pandemic Among US Health Care Workers
Authors: Elizabeth M. Harry, Lindsey E. Carlasare, Christine A. Sinsky, Roger L. Brown, Elizabeth Goelz, Nancy Nankivil, Mark Linzer
Journal: JAMA Network Open (2022)

<h3>Importance</h3> Childcare stress (CCS) is high during the COVID-19 pandemic because of remote learning and fear of illness transmission in health care workers (HCWs). Associations between CCS and burnout, intent to reduce (ITR) hours, and intent to leave (ITL) are not known. <h3>Objective</h3> To determine associations between CCS, anxiety and depression, burnout, ITR in 1 year, and ITL in 2 years. <h3>Design, Setting, and Participants</h3> This survey study, Coping with COVID, a brief work-life and wellness survey of US HCWs, was conducted between April and December 2020, assessing CCS, burnout, anxiety, depression, workload, and work intentions. The survey was distributed to clinicians and staff in participating health care organizations with more than 100 physicians. Data were analyzed from October 2021 to May 2022. <h3>Main Outcomes and Measures</h3> The survey asked, "due to…COVID-19, I am experiencing concerns about childcare," and the presence of CCS was considered as a score of 3 or 4 on a scale from 1, not at all, to 4, a great extent. The survey also asked about fear of exposure or transmission, anxiety, depression, workload, and single-item measures of burnout, ITR, and ITL. <h3>Results</h3> In 208 organizations, 58 408 HCWs (15 766 physicians [26.9%], 11 409 nurses [19.5%], 39 218 women [67.1%], and 33 817 White participants [57.9%]) responded with a median organizational response rate of 32%. CCS was present in 21% (12 197 respondents) of HCWs. CCS was more frequent among racial and ethnic minority individuals and those not identifying race or ethnicity vs White respondents (5028 respondents [25.2%] vs 6356 respondents [18.8%];<i>P</i> &lt; .001; proportional difference, −7.1; 95% CI, −7.8 to −6.3) and among women vs men (8281 respondents [21.1%] vs 2573 respondents [17.9%]; odds ratio [OR], 1.22; 95% CI, 1.17 to 1.29). Those with CCS had 115% greater odds of anxiety or depression (OR, 2.15; 95% CI, 2.04-2.26;<i>P</i> &lt; .001), and 80% greater odds of burnout (OR, 1.80; 95% CI, 1.70-1.90;<i>P</i> &lt; .001) vs indidivuals without CCS. High CCS was associated with 91% greater odds of ITR (OR, 1.91; 95% CI, 1.76 to 2.08;<i>P</i> &lt; .001) and 28% greater odds of ITL (OR, 1.28; 95% CI, 1.17 to 1.40;<i>P</i> &lt; .001). <h3>Conclusions and Relevance</h3> In this survey study, CCS was disproportionately described across different subgroups of HCWs and was associated with anxiety, depression, burnout, ITR, and ITL. Addressing CCS may improve HCWs' quality of life and HCW retention and work participation.
Prussian Blue Nanozyme Normalizes Microenvironment to Delay Osteoporosis
Authors: Chenyi Ye, Wei Zhang, Yongzheng Zhao, Kai Zhang, Weiduo Hou, Mo Chen, Jinwei Lu, Jianrong Wu, Rongxin He, Wei Gao, Yuanyi Zheng, Xiaojun Cai
Journal: Advanced Healthcare Materials (2022)

Abstract Osteoporosis (OP) is the most common orthopedic disease in the elderly and the main cause of age‐related mortality and disability. However, no satisfactory intervention is currently available in clinical practice. Thus, an effective therapy to prevent or delay the development of OP should be devised. Osteoclastogenesis overactivation and excessive bone resorption are the main characteristics of OP. Accordingly, a paradigm for nanozyme‐mediated normalization of the disease microenvironment to regulate osteoclast differentiation and delay OP is proposed. Hollow Prussian blue nanozymes (HPBZs) are prepared via template‐free hydrothermal synthesis and selected as representative nanozymes. The intrinsic osteoclast activity‐remodeling bioactivities of the HPBZs are explored in vitro and in vivo, focusing on their impact on osteogenesis and specific molecular mechanisms using an OP murine model. The HPBZs significantly normalize the OP microenvironment, thereby inhibiting osteoclast formation and osteoclast resorption, possibly owing to the suppression of intracellular reactive oxygen species generation, the mitogen‐activated protein kinase, and nuclear factor κ B signaling pathways. Consistently, in an ovariectomy‐induced OP murine model, HPBZ treatment significantly attenuates osteoporotic bone loss in vivo. The findings confirm the HPBZ‐mediated normalization of the disease microenvironment for the treatment of OP and suggest its application to other inflammation‐related diseases.
Highly Sensitive <i>EGFRvIII</i> Detection in Circulating Extracellular Vesicle RNA of Glioma Patients
Authors: Syeda Maheen Batool, Koushik Muralidharan, Tiffany Hsia, Sarah Falotico, Austin S. Gamblin, Yulia B. Rosenfeld, Sirena K. Khanna, Leonora Balaj, Bob S. Carter
Journal: Clinical Cancer Research (2022)

Liquid biopsy offers an attractive platform for noninvasive tumor diagnosis, prognostication, and prediction of glioblastoma clinical outcomes. Prior studies report that 30% to 50% of GBM lesions characterized by EGFR amplification also harbor the EGFRvIII mutation.A novel digital droplet PCR (ddPCR) assay for high GC content amplicons was developed and optimized for sensitive detection of EGFRvIII in tumor tissue and circulating extracellular vesicle RNA (EV RNA) isolated from the plasma of patients with glioma.Our optimized qPCR assay detected EGFRvIII mRNA in 81% [95% confidence interval (CI), 68%-94%] of EGFR-amplified glioma tumor tissue, indicating a higher than previously reported prevalence of EGFRvIII in glioma. Using the optimized ddPCR assay in discovery and blinded validation cohorts, we detected EGFRvIII mutation in 73% (95% CI, 64%-82%) of patients with a specificity of 98% (95% CI, 87%-100%), compared with qPCR tumor tissue analysis. In addition, upon longitudinal monitoring in 4 patients, we report detection of EGFRvIII in the plasma of patients with different clinical outcomes, rising with tumor progression, and decreasing in response to treatment.This study demonstrates the feasibility of detecting EGFRvIII mutation in plasma using a highly sensitive and specific ddPCR assay. We also show a higher than previously reported EGFRvIII prevalence in glioma tumor tissue. Several features of the assay are favorable for clinical implementation for detection and monitoring of EGFRvIII-positive tumors.
Engaging Pediatric Subspecialists in Pursuit of Health Equity—Breaking Out of the Silo
Authors: Keila N. Lopez, Elena Fuentes-Afflick
Journal: JAMA Pediatrics (2022)

This Viewpoint discusses engaging pediatric subspecialists to increase disparities-focused research, create interventions that promote health equity, and diversify the subspecialty workforce in an effort to close the health disparities gap.